The hospice industry is expanding dramatically. The number of hospices has more than doubled from 1,600 in 1990 to over 3,600 in 2004. Despite this dramatic growth in hospice and increasing evidence of its benefits to patients with serious illness and their families, only 20% of older adults who die each year elect to receive hospice services. The availability of hospice nationally is an unstudied, yet potentially key factor in understanding hospice use. Studying the distribution of hospices nationally is also important for identifying the types of communities, in terms of racial and ethnic composition, income profile, degree of rurality and other factors, where gaps in the availability of hospice exist. A second critical aspect of understanding access to hospice is the types of services provided to patients and families that do access hospice. Recent evidence suggests that there is substantial variation across hospices in the care provided to patients and families; however, detailed assessments of such variability and the key processes of care used to deliver hospice services are lacking. Such information is instrumental to improving the quality of hospice care across the country. To address these issues, I will examine the availability of hospice nationally by estimating the percentage of older individuals in the U.S. that live too far from a hospice agency to have reasonable access to hospice services. I will use a novel technique involving the calculation of driving times between population centers and the nearest hospice agency to estimate the percentage of older individuals without reasonable access to hospice, and how this has changed over time. I will determine how availability of hospice varies by key characteristics of communities including demographic and socioeconomic factors. Last, I will conduct a qualitative study to develop a taxonomy of key processes of care used to deliver hospice services and generate hypotheses about potential predictors of variation in these key processes of care to be tested in a future study. Relevance to public health: This research will determine the percentage of older adults that live too far from a hospice agency to have reasonable access to hospice services. It will identify how availability hospice varies across communities that differ in terms of racial and ethnic composition, income, and degree of rurality. This information is critical for understanding disparities in use of hospice and for informing policies to increase the availability of hospice to patients with terminal illness and their families. [unreadable] [unreadable] [unreadable]